Patients with angina without obstructive coronary artery disease are increasingly recognized and microvascular disease (MVD) is thought to play a significant role. An abnormal myocardial perfusion reserve (MPR) by positron emission tomography is predictive of increased cardiovascular events, particularly in women, diabetics, and those with metabolic syndrome. We hypothesized that MPR as measured by CMR would be reduced in patients with angina or anginal equivalent symptoms and non-obstructive CAD/normal coronaries compared with asymptomatic controls.

Patients with MVD and no significant epicardial coronary disease have reduced global MPR compared to asymptomatic controls as demonstrated by quantitative CMR perfusion imaging, likely due, in part, to endothelial dysfunction. This may contribute to their chest pain syndrome and adverse cardiovascular prognosis. Quantitative CMR perfusion imaging is a promising approach for its identification.

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